tbuckley/cabot-search huggingface dataset:
Abstract 15121: Specialty Care Visits and Likelihood of Mortality for Children With Congenital Heart Disease
Authors: Devin Parker, Meagan Stabler, Todd Mackenzie, Meghan Zimmerman, Xun Shi, Jeremiah R Brown
Journal: Circulation (2022)

Introduction: Congenital heart disease (CHD) is the most common birth defect and is estimated to affect nearly 37,500 infants born each year in the United States. Children with CHD have complex, nuanced, healthcare needs and frequently require multi-specialty care. The relationship between specialty care utilization and survival for children with CHD is not well known. Methods: We analyzed all payer claims data (APCD) from Colorado from 2012-2019. Children with CHD were identified by applying harmonized ICD-9-CM and ICD-10-CM diagnoses codes. We included children with CHD &lt; 18 years of age who resided in Colorado, had a documented zip code, and had at least one healthcare claim. Specialty care providers were uniquely identified by their National Provider ID. Mortality was defined by discharge status. We evaluated the relationship between specialty care provider visits and mortality using logistic multivariable modeling. Results: There were 24,784 children diagnosed with CHD in Colorado from 2012 - 2019. Of those, 22,413 (90.4%) children had at least one specialty care visit and 465 (2.1%) died during the study period. Children that died had an average of 60 visits per year, while children that survived had an average of 29 visits (p=&lt;0.001). Children primarily commercially insured by are 25% less likely to experience death (OR: 0.75, 95% CI (0.58 - 0.97), p value: &lt;0.001). Children with greater CHD disease severity or presence of a genetic disorder are nearly 2 times more likely to die, and children in the highest community level quartile are less likely to die. Conclusions: In our cohort of children diagnosed with CHD from 2012 - 2019, there was a significant association with the frequency of specialty care visits and likelihood of death. We found that the primary insurer, level of disease severity, presence of any genetic disorder and community level household income were significantly associated with higher likelihood of death.
Abstract 14672: Regulation of Succinate Signaling and Immunometabolism in Diabetes-Associated Atherosclerosis by Microrna-369-3p
Authors: Shruti Rawal, Syed Husain M Rizvi, Akm Wara, Madhur Sachan, Vinay Randhawa, Robert M Weisbrod, John Asara, Naomi M Hamburg, Mark W Feinberg
Journal: Circulation (2022)

Introduction: The risk of atherosclerotic cardiovascular disease (ASCVD) is increased in people with diabetes. Diabetes (D) is associated with impaired metabolism and functionality of macrophages (Mps), resulting in chronic inflammation. Identifying factors to combat metabolic alterations and promote resolution of inflammation remains an unmet goal. microRNAs (miRs) orchestrate multiple signaling events in Mps and regulate inflammation. Hypothesis: miR-369-3p regulates metabolic reprogramming in Mps during diabetes-associated atherosclerosis (D-AS). Methods and Results: miRNA-seq profiling from aortic intimal lesions of LDLR-/- mice on a high-fat sucrose containing (HFSC) diet revealed miR-369-3p downregulation with D-AS progression. miR-369-3p was also downregulated in PBMCs derived from D and D-associated ASCVD patients. Cell-type profiling showed miR-369-3p enrichment in mouse bone marrow derived Mps (BMDMs). oxLDL-stimulated BMDMs (foam cells, FCs) resulted in marked downregulation of miR-369-3p, increased secretion of IL1-β, and metabolic shift of oxidative phosphorylation (OXPHOS) to glycolysis, while miR-369-3p overexpression (miR-369-3p O/E) favored OXPHOS over glycolysis and reduced IL1-β secretion. Metabolomics revealed succinate, a key immunometabolite was profoundly elevated extracellularly from FCs, while miR-369-3p O/E reversed this phenotype. Extracellular succinate activates its receptor, GPR91. Indeed, GPR91 was upregulated in FCs while miR-369-3p O/E significantly repressed GPR91. 3’UTR luciferase reporter assay confirmed GPR91 as a miR-369-3p target. miR-369-3p O/E dampened GPR91-mediated inflammasome activation and mitochondrial dysfunction in FCs by decreasing p-ERK, p-DRP1, and NLRP3. Therapeutic delivery of miR-369-3p in LDLR-/- mice fed HFSC diet for 12 weeks reduced plaque size by ORO staining and plasma IL1-β. Flow cytometry of aortic Mps revealed that miR-369-3p decreased GPR91 expression by ~50%, along with a decrease in M1 and increase in M2-like-Mps. Conclusions: miR-369-3p confers a pro-resolving role in regulating lipid-driven inflammation and metabolic rewiring in Mps via targeting GPR91 and preventing D-AS plaque progression.
Abstract 14873: Analysis of Heart Failure Re-Admissions and In-Hospital Outcomes in Patients With Takotsubo Syndrome
Authors: Dhrubajyoti Bandyopadhyay, Aaqib H Malik, Akshay Goel, Rahul Gupta, Theresa Maitz, Wilbert S Aronow, Toshiki Kuno, Alexandros Briasoulis, Daniel Spevack, Gregg M Lanier, Julio A Panza
Journal: Circulation (2022)

Background: Takotsubo Syndrome (TTS) is characterized by transient reduction in left ventricular function with in the absence of obstructive coronary artery disease. Clinical presentation often mimics acute myocardial infarction (AMI). Patients with TTS have comparable long-term mortality with AMI patients. However, data on the burden of heart failure (HF) readmissions in patients with TTS are scarce. Methods: This retrospective analysis utilized the US Nationwide Readmission Database for the years 2012-2019 to identify hospitalizations for TTS or AMI. The primary outcome of interest was 6-month readmission due to HF. Secondary outcomes included in-hospital mortality. Results: There were 30,926 hospitalizations with TTS and 2,535,025 hospitalizations with AMI. The proportion of women was 90% among TTS patients and 37.7% among AMI patients (p&lt;0.001). Overall comorbidities were similar between the two groups, but in-hospital mortality during index admission was higher in the AMI arm (6.5% vs 1.5% in TTS, p &lt;0.01) accompanied with increased in-hospital complications. All-cause readmission rates were lower among TTS than among AMI patients (21.9% vs. 29.4%; p &lt;0.01). HF readmissions were also lower among TTS than AMI patients (3.7% vs. 6.7%; p &lt;0.01). After propensity matching, all-cause readmission rate remained lower among TTS than among AMI patients (21.9% vs. 27.9%; p &lt;0.01). HF hospital readmissions rates were also lower among TTS patients (3.7% vs 5.7%; p &lt;0.01). Independent predictors of HF readmission in TTS population included comorbidities such as diabetes mellitus, atrial fibrillation, chronic kidney disease, peripheral vascular disease, and chronic pulmonary disease. Conclusion A substantial proportion of patients (&gt;20%) with TTS suffer a hospital readmission within 6 months, although less than 5% are readmitted with HF. Compared with AMI, all-cause and HF readmission rates are lower in TTS patients.
Abstract 14531: Intracardiac versus Transvenous Pacemaker Implantation: Impact on Clinical Outcomes and Healthcare Utilization
Authors: Anton Mararenko, Ndausung Udongwo, Mihir Odak, Joseph Heaton, Viraaj Pannu, Steven Douedi, Abbas Alshami, Kameron Tavakolian, Arif Asif, arman mushtaq, Brett Sealove, Eran S Zacks
Journal: Circulation (2022)

Introduction: Permanent pacemakers are frequently used to treat disorders of cardiac rhythms. Recently, intracardiac (leadless) pacemakers offer potential treatment with an alternative insertion procedure due to their novel design. Literature comparing hospitalization outcomes between the devices is scarce. We aim to assess the impact of intracardiac pacemakers on readmissions and hospitalization trends. Methods: We analyzed the National Readmissions Database (NRD) from 2016 to 2019 seeking patients admitted for sick sinus syndrome, second-degree or third-degree AV block who received either a transvenous pacemaker or an intracardiac pacemaker. Patients were stratified by device type and assessed for 30-day readmissions, inpatient mortality, and length of stay. Descriptive statistics, Cox proportional hazards and multivariate regressions were used to compare the groups. Results: During the studied period, 21,782 patients met the inclusion criteria. Transvenous pacemakers were implanted in 17,677 patients and intracardiac pacemakers implanted in 4,017 patients. The mean age was 81.07 years, and 45.52% were female. No statistical difference was noted for readmissions (HR 1.14, 95% CI 0.92 - 1.41, p = 0.225) and inpatient mortality (HR 1.36, 95% CI 0.71 - 2.62, p = 0.352) between transvenous and intracardiac groups. Kaplan-Meier curves for readmission and mortality are presented in Figure 1A and 1B, respectively. Multivariate linear regression revealed that length of stay was 0.54 (95% CI 0.26 - 0.83, p &lt; 0.001) days longer for intracardiac group. Conclusion: Hospitalization outcomes associated with intracardiac pacemakers are comparable to traditional transvenous pacemakers. Patients may benefit from the use of this new device without incurring additional resource utilization. Further studies are needed to compare long term outcomes between transvenous and intracardiac pacemakers.
Abstract 14518: Social Determinants of Health Impact Cardiac Rehabilitation Referral and Participation Patterns Among Patients With Coronary Heart Disease
Authors: David Torres Barba, Santiago Ramirez Nuno, David Dang, Armando Gallegos, Alexandra Maloof Zapata, Luis R Castellanos
Journal: Circulation (2022)

Introduction: Cardiac Rehabilitation (CR) is a medically supervised preventative cardiovascular program recommended following cardiovascular illnesses. Although the benefits of CR are well-studied and participation considered a Class Ia recommendation, referral and participation rates are low. Hypothesis: We hypothesized socioeconomic factors negatively impact participation and referral patterns among individuals with CHD. Methods: Our prospective study included 561 patients hospitalized with ACS to University of California San Diego Medical Centers in Southern California. Participants included adult patients 18 years or older from rural and urban communities admitted for percutaneous coronary intervention, coronary artery bypass grafting, or acute myocardial infarction. Baseline characteristics were compared by paired t-tests and chi-square analysis for continuous and categorical variables, respectively. Univariable and multivariable logistic regression models were utilized to assess the impact socioeconomic factors have on CR referral and participation patterns. Results: Of the 561 enrolled participants, 317 were referred to CR. Income, language, and urban/rural setting were found to be statistically significant in the univariate and multivariate analysis with those with incomes above 60 K/year being 1.73 times more likely to be referred than those with income &lt;30K/year (95% CI 1.00-2.99), English speakers 3.53 times more likely to be referred than Spanish speakers (95% CI 1.83-6.94), and those in urban settings 2.12 times more likely to be referred than those in rural settings (95% CI 1.29-3.50). Among the 317 referred patients, 75.4% participated in at least one CR session. In those referred, after adjusting for cofounding factors, language and city setting were the most significant factors impacting participation, with English speakers being 3.8 times more likely to participate than Spanish speakers (95% CI 1.28-11.99), and those living in urban setting being 2.33 times more likely to participate than those living in rural areas (95% CI 1.00-5.37). Conclusions: The identification of significant socioeconomic factors can help implement institutional initiatives that eliminate the disparities identified.
Abstract 15900: Impact of Age on Readmission Following Mitraclip; National Readmission Database
Authors: Demetrio Sharp Dimitri, Benjamin J Becerra, Donald Lynch
Journal: Circulation (2022)

Transcatheter mitral valve repair with the Mitraclip device has become a therapeutic option for patients with moderate to severe mitral regurgitation (MR) and high surgical risk. There are limited data evaluating Mitraclip outcomes in younger patients, although limited studies suggest decreased mortality in younger patients. As severe MR has increasing become recognized in younger patients, there is a need to investigate outcomes with Mitraclip in these subjects. Based on limited available data, our hypothesis was adverse clinical outcomes, including readmission, would be significantly lower among younger subjects following Mitraclip. The National Readmission Database (NRD) for 2018 and 2019 was queried to identify patients undergoing transcatheter mitral valve repair using ICD-10 procedure code ‘02UG3JZ’. Patients were stratified into 3 age groups: &lt; 65, 65-80, and &gt; 80 years of age (yoa) for comparison of readmission rates and risk factors. A total of 9742 who underwent Mitraclip were included in the study. The mean age of included subjects was 77 yoa, and 56 % were male. Approximately 16% had diabetes, 70% had hypertension, and 27% had chronic lung disease. Approximately 87% of subjects had Medicare coverage, while 3% had Medicaid, and 8% had private insurance. Approximately 90% of patients were cared for in 90% teaching hospitals. The overall rate of readmission following Mitraclip was 14%. While there was no difference in readmission by sex for subjects &lt; 65 or &gt; 80, there was a significant increase in readmission for women in comparison to men who were 65-80 yoa (15.8 vs. 12.4%, P &lt; 0.01). There was a significant decrease in rate of readmission for subjects &gt; 80% in 2019 in comparison to 2018 (13.1 vs. 15.5%, P = 0.03). There was significant increase in readmission to teaching hospitals in comparison to non-teaching hospitals for individuals &lt; 65 (15.0 vs. 9.8%, P &lt; 0.01). Rate of readmission was significantly higher for individuals &gt; 80 and 65-80 yoa with chronic lung disease (17.7 vs 13.1%, P &lt; 0.01). For all studied age groups, uncontrolled hypertension was associated with increased rate of readmission (P &lt;0.02). Our studies suggest overall similar outcomes for younger patients undergoing Mitraclip in comparison to other populations.
Abstract 14711: Radial Artery Patency Following Distal Transradial Access in Patients With Advanced Chronic Kidney Disease
Authors: Ramya C Mosarla, Hamza Ahmed, Shaline Rao, Bernard Kadosh, Jennifer Cruz, Randal Goldberg, Tajinderpal Saraon, Bruce Gelb, Aprajita Mattoo, Sunil V Rao, Sripal Bangalore
Journal: Circulation (2022)

Background Radial artery occlusion (RAO) with transradial access is reported in 6-9% of patients with advanced chronic kidney disease (CKD) and may preclude the creation of an arteriovenous fistula for dialysis. Distal transradial access (dTRA) has lower rates of RAO compared with proximal transradial access but studies excluded patients with advanced CKD. Methods: We sought to define procedure characteristics and RAO rates with dTRA in CKD. Patients who underwent cardiac catheterization with dTRA from 01/01/2019 to 01/01/2022 with follow-up of radial artery patency by reverse Barbeau or repeat access of the artery were included. Results: A total of 68 patients with a median age of 60 (IQR 54-69), 50 (74%) males were included. A total of 44 (65%) were on hemodialysis. Of the procedures, 59 (87%) were diagnostic and 9 (13%) were PCIs. Access was ultrasound guided, a majority (79%) were right dTRA and all had spasmolytic therapy and patent hemostasis. Sheaths were 5 French short (7 cm) in 40 (59%) and 6 French short in 28 (41%). Mean contrast volume was 20+/-11 ml for diagnostic procedures and 91+/-53 ml for PCIs. Mean radiation exposure was 290+/-156 mGy for diagnostic procedures and 1692+/-961 mGy for PCIs. Mean fluoro time was 5+/-4 mins for diagnostic procedures and 24+/-13 mins for PCIs . Of 9 patients with PCIs, mean number of stents was 2+/-1 and atherectomy was used in 2 (22%) PCIs. The median number of diagnostic catheters was 1(IQR 1-2) and median guides was 1(IQR 1-1) in PCIs. Radial arteries were patent in 68 (100%) at follow-up. (Figure 1) Conclusions: Our cohort demonstrates safety of dTRA in patients with advanced CKD with high rates of radial artery patency.
Abstract 14466: Recurrent Heart Block Due to Cardiac Sarcoidosis in a Patient With Interrupted Glucocorticoid Therapy
Authors: Todd Nagamine, Witina Techasatian, Mohammed Ali, Maan Kathryn Gozun, Kevin Benavente, Jason Kuniyoshi, Jihun Yeo, James Zhang, Parthav Shah, Dipanjan Banerjee
Journal: Circulation (2022)

Background: Cardiac involvement is a major cause for mortality in patients with systemic sarcoidosis. Atrioventricular (AV) block caused by inflammation involving the conduction system is one of the major manifestations of cardiac involvement. The mainstay of management is immunosuppressive therapy and device implantation if high degree AV block is present. However, there is lack of evidence regarding the appropriate dose and duration of corticosteroids in the treatment of cardiac sarcoidosis. Case summary: We describe the case of a 62-year-old man who presented with symptoms of dyspnea and bradycardia and was found to be in second degree AV block type II. Computed tomography of the chest showed hilar lymphadenopathy. Echocardiography revealed reduced systolic function (LVEF of 35-40%). A FDG-PET scan showed hypermetabolic activity of the interventricular septum and pericardium consistent with sarcoidosis. Bronchoscopy with BAL and EUS biopsies revealed necrotizing granulomas consistent with pulmonary sarcoidosis. ICD/pacemaker implantation was discussed; however the patient deferred and ultimately underwent Boston Scientific ILR placement to monitor for arrhythmias. He was started on methotrexate and prednisone with improvement in heart rate from 2:1 AV block (rates 30's) to sinus rhythm with rates in the 60's. Subsequent stress testing demonstrated improvement in heart rate with exercise to 113 bpm. His AV block had decreased in frequency per Implantable loop recorder (ILR) monitoring. A month later, the patient stopped taking prednisone and methotrexate and developed a symptomatic recurrence of 2:1 AV block. He then underwent dual chamber pacemaker implantation with ILR explant. Discussion: This case highlights the importance of maintaining and educating patients about long term immunosuppressive treatment in cardiac sarcoidosis to prevent recurrence of conduction abnormalities. The initial dose for those receiving prednisone is typically 40mg daily, while for those patients receiving an additional immunosuppressive agent, the initial dose can be 20mg daily. Based on response to treatment after 1 to 3 months, immunosuppressive therapy should be continued for an additional 9 to 12 months.
Abstract 14675: High-Throughput CRISPR Screening Links CAD Loci to Endothelial Cell Programs and Causal Pathways
Authors: Rajat M Gupta, Gavin R Schnitzler, Helen Kang, Rosa R Ma, Vivian Lee-Kim, Anthony Zeng, Ronghao Zhou, Shamsudheen K Vellarikkal, Oscar Sias, Glen Munson, Katherine Guo, Brian Cleary, Eric Lander, Jesse M Engreitz
Journal: Circulation (2022)

Introduction: Genome-wide association studies (GWAS) have discovered &gt;300 associations for CAD. Few loci are functionally characterized and may represent new mechanisms of disease. Hypothesis: Can a high-throughput, unbiased transcriptional screen for all candidate GWAS genes identify the causal genes and biological pathways at CAD GWAS loci in endothelial cells (ECs)? Methods: We applied CRISPRi-Perturb-seq to knock down the expression of all genes within 500 Kb of coronary artery disease GWAS loci (2,300 genes in total) and measure their effects on the transcriptome using single-cell RNA-seq. Results: We identified 60 programs of co-expressed genes, which represent core cellular pathways (i.e. ribosome biogenesis) and EC-specific pathways such as flow response and angiogenesis. The EC-specific programs show the greatest contribution to CAD heritability. 6 EC-specific programs have the greatest number of CAD GWAS candidate genes. One of the EC-specific programs had genes regulated by KLF -transcription factors and was enriched for shear-stress response genes. The novel CAD candidate genes in this program included multiple known mediators of the cerebral cavernous malformation (CCM)-signaling complex. 9 known members of the CCM-signaling cascade and several potentially novel mediators of CAD clustered together in the KLF Perturb-seq topic. These included genetic variants in the CCM2 , KLF4 , RAC1 , and HEG1 loci as well as genes will a similar transcriptional profile but no prior connection to the CCM-signaling complex. Conclusions: High-throughput functional analysis of 2,300 genes proximal to CAD GWAS loci prioritized pathways—such as angiogenesis and EC migration—that are regulated by multiple risk SNPs. Our study identifies new genes that likely influence risk for CAD, identifies convergence of CAD genes into certain pathways in endothelial cells, and demonstrates a generalizable strategy to connect disease variants to functions.
Abstract 15314: Advanced Cardiovascular Imaging for the Diagnosis of Mycobacterium Chimaera Prosthetic Valve Infective Endocarditis After Open-Heart Surgery: A Systematic Review
Authors: Alejandro Sanchez-Nadales, Alejandra V Diaz Sierra, Bo Xu
Journal: Circulation (2022)

Introduction: Mycobacterium chimaera is an emerging pathogen, recognized to cause prosthetic valve infective endocarditis (PVIE) and disseminated infection following open-chest cardiac surgery with certain contaminated heater-cooler systems. Diagnosis is challenging and requires a very high index of suspicion. Data regarding the optimal cardiac imaging evaluation of this condition is limited. Methods: Scopus, PubMed, EMBASE, Ovid and Cochrane were searched for published articles through October 2021, using keywords “Mycobacterium chimaera”, “Prosthetic valve” and “Endocarditis”. 169 articles were found and reviewed for study eligibility. Articles were included if they consisted of Mycobacterium chimaera causing IE, with imaging modalities used to establish diagnosis Results: Thirty-three articles were included, yielding twenty-two cases of Mycobacterium chimaera PVIE. The disease manifested on average thirty months after surgery, with an average patient age of 59 years (90% male). Imaging modalities to establish the diagnosis of prosthetic valve infective endocarditis included: transthoracic echocardiogram in 5 cases, transesophageal echocardiogram (TEE) in nine cases, 18F-FDG-PET/CT in seven cases. A combination of imaging modalities with TEE and 18F-FDG-PET/CT was reported once; TTE, TEE and 18F-FDG-PET/CT was also noted in one case. Lastly there was one instance each of combined use of TTE, TEE, and one of the following: CTA, Cardiac MRI, or standard CT. Nine cases did not specify the imaging modality used to achieve diagnosis. Ten patients died. Conclusions: PVIE due to Mycobacterium chimaera infection is a rare and challenging diagnosis, which requires a high index of suspicion. Accurate diagnosis should be aided by multimodality cardiac imaging, with 18F-FDG-PET/CT being a powerful adjunct imaging modality.